There are several fundamental models for health insurance, each with strengths and weaknesses. There is no single health insurance plan that is the best for everyone. Family size and make-up, health history, anticipated health events (births, elective surgery, etc.) all play an important role in deciding on the right kind of coverage. Many people choose to adjust their coverage every year, during their employer's open enrollment period. Open enrollment is a special time of the year when you can change your employer-sponsored medical plan without penalty. Changing plans at other times requires a "significant life event" to be permitted. Trust me, most qualifying significant life events are not fun, so be sure to take advantage of open enrollment.
The least expensive, and therefore least flexible, plans are called Health Maintenance Organizations, or HMOs. This insurance connects you to a pre-defined set of doctors, specialists and hospitals. You choose one doctor who is your gateway to all medical services, called your primary care physician. This doctor sees you when you are sick and refers you to specialists within the HMO group if needed. Everything you need is provided by this group. If you don't go outside this group, the medical coverage is pretty inexpensive (relatively speaking of course) but if you want to see a doctor outside the group or don't want to wait for a referral from your primary care physician things get expensive fast.
One middle ground that is gaining popularity is the third option, called a Point of Service, or POS plan. This is a blend of HMO and PPO features. You must select a primary care physician, who manages your access to health services, but you retain the ability to go out of network (at a significantly higher cost to you). This makes sense for people who are happy with HMO services but have one favorite specialist who is not in their HMO plan.
No matter which plan you choose, remember that the ultimate responsibility for getting good medical care rests with you. Get second opinions before undertaking medical procedures. Ask about alternatives and do some research on your own before accepting treatment plans. Your interests don't exactly match the interests of your provider.
Keep all of your records and bills. Many times a hospital will bill you before they bill the insurance carrier. Wait for the Explanation of Benefits statement that you will get from your insurer before making any payments of your own. It is really hard to get money back from a hospital or doctor. But don't ignore medical bills. The hospital routinely passes unpaid bills to collection agencies and this can damage your credit long after your medical procedure has returned you to health.
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